Combinations of cannabinoids and n-acylethanolamines

ABSTRACT

The present invention provides pharmaceutical compositions comprising cannabinoids and N-acylethanolamines, and methods for their use in preventing and treating a variety of cannabinoid-treatable conditions.

FIELD OF THE INVENTION

The present invention relates to compositions and methods forpotentiating therapeutic effects and/or reducing side-effects ofselected cannabinoids of the plant genus Cannabis. The present inventionprovides pharmaceutical compositions comprising cannabinoids andN-acylethanolamines, and methods for their use in a variety ofindications amenable to treatment with cannabinoids.

BACKGROUND OF THE INVENTION

Cannabinoids are a class of diverse chemical compounds that act oncannabinoid receptors on cells that repress neurotransmitter release inthe brain. Cannabinoid receptors are of a class of cell membranereceptors under the G protein-coupled receptor superfamily. As istypical of G protein-coupled receptors, the cannabinoid receptorscontain seven transmembrane spanning domains. There are currently twoknown subtypes of cannabinoid receptors, termed CB1 and CB2, withmounting evidence of more. The CB1 receptor is expressed mainly in thebrain (central nervous system), but also in the lungs, liver andkidneys. The CB2 receptor is expressed mainly in the immune system andin hematopoietic cells. The protein sequences of CB1 and CB2 receptorsare about 44% similar.

Phyto-cannabinoids (those derived from the Cannabis plant) include butnot limited to: tetrahydrocannabinol (THC), tetrahydrocannabinolic acid(THCA), cannabidiol (CBD), cannabinol (CBN), Cannabigerol (CBG),Cannabichromene (CBC), Cannabicyclol (CBL), Cannabivarin (CBV),Tetrahydrocannabivarin (THCV), Cannabidivarin (CBDV), Cannabichromevarin(CBCV), Cannabigerovarin (CBGV) and Cannabigerol Monomethyl Ether(CBGM). The main way in which the cannabinoids are differentiated isbased on their degree of psycho-activity. For example, CBG, CBC and CBDare not known to be psychologically active agents whereas THC, THCA, CBNand CBDL along with some other cannabinoids are known to have varyingdegrees of psycho-activity.

The most notable cannabinoid is the phyto-cannabinoidΔ9-tetrahydrocannabinol (THC), which is the primary psychoactivecomponent of the cannabis plant. THC has approximately equal affinityfor the CB1 and CB2 receptors, and it possess activities as apsycho-active agent, analgesic, muscle relaxant, anti-spasmodic,bronchodilator, neuro-protective, anti-oxidant and anti-pruritic agent.

Dronabinol is the International Nonproprietary Name (INN) for a pureisomer of THC, (−)-trans-Δ9-tetrahydrocannabinol. Synthesized dronabinolis marketed as Marinol. Marinol has been approved by the U.S. Food andDrug Administration (FDA) in the treatment of anorexia in AIDS patients,as well as for refractory nausea and vomiting of patients undergoingchemotherapy. An analog of dronabinol, nabilone, a Schedule II drug withtherapeutic use as an antiemetic and as an adjunct analgesic forneuropathic pain, is available commercially in Canada under the tradename Cesamet. Cesamet has also received FDA approval and began marketingin the U.S. in 2006.

Sativex is the first natural cannabis plant derivative to gain fullmarket approval. Sativex is a mouth spray for multiple sclerosis(MS)-derived neuropathic pain, spasticity, overactive bladder, and othersymptoms. Each spray delivers a near 1:1 ratio of Cannabidiol (CBD) toTHC, with a fixed dose of 2.7 mg THC and 2.5 mg CBD.

Tourette syndrome (also called Tourette's syndrome, Tourette's disorder,Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette'sor TS) is an inherited neuropsychiatric disorder with onset inchildhood, characterized by multiple physical (motor) tics and at leastone vocal (phonic) tic. Tourette's is defined as part of a spectrum oftic disorders, which includes provisional, transient and persistent(chronic) tics.

In Tourette syndrome, several anecdotal reports provided evidence thatmarijuana might be effective not only in the suppression of tics, butalso in the treatment of associated behavioral problems (Muller-Vahl KR, Behavioural Neurology, 2013, 27, 119-124). There are currently onlytwo controlled trials available investigating the effect of THC in thetreatment of TS, and in both studies tic reduction could be observedafter treatment with THC compared to placebo. In the first study, adultTS patients were treated with a single dose of placebo or with 5, 7.5 or10 mg THC (Muller-Vahl K R et al., Pharmacopsychiatry, 2002; 35(2):57-61). Using the self-rating scale Tourette Syndrome Symptom List(TSSL) a significant global tic improvement was found after THC comparedwith placebo (p=0.015). However, the data became more robust whenincluding only those patients who had received 7.5 or 10.0 mg THC,suggesting that higher dosages are more effective. In the second study,adult TS patients were treated with placebo or with 2.5 mg THC per day.The dosage was increased by 2.5 mg every four days to the target dosageof 10 mg. If a patient was unable to tolerate the maximum dose, themedication was reduced by up to 5.0 mg/day until a tolerated dose wasachieved (Muller-Vahl K R et al, J. Clin. Psychiatry, 2003; 64(4):459-65). The study consisted of 6 visits (visit 1=baseline, visits 2-4during treatment, visits 5 and 6 after withdrawal). Using the GlobalClinical Impression Scale (GCIS), at visits 3 and 4, respectively, asignificant difference (p<0.05) was found between the THC and placebogroups.

Further limitations and disadvantages of conventional and traditionalapproaches will become apparent to one of skill in the art, thoughcomparison of such systems with some aspects of the present invention asset forth in the remainder of the present application with reference tothe drawings.

N-acylethanolamines (NAEs) are lipid-derived signaling molecules. Theyare formed when one of several types of acyl group is linked to thenitrogen atom of ethanolamine. Examples of N-acylethanolamines includeanandamide (the amide of arachidonic acid (20:4 Ω-6) and ethanolamine),N-Palmitoylethanolamine (the amide of palmitic acid (16:0) andethanolamine), N-Oleoylethanolamine (the amide of oleic acid (18:1) andethanolamine), N-Stearoylethanolamine (the amide of stearic acid (18:0)and ethanolamine) and N-Docosahexaenoylethanolamine (the amide ofdocosahexaenoic acid (22:6) and ethanolamine).

Palmitoylethanolamide (PEA, also known asN-(2-hydroxyethyl)hexadecanamide; Hydroxyethylpalmitamide; palmidrol;N-palmitoylethanolamine; and palmitylethanolarnide) is an endogenousfatty acid amide, belonging to the class of nuclear factor agonists. PEAhas been demonstrated to bind to a receptor in the cell nucleus (anuclear receptor) and exerts a variety of biological functions relatedto chronic pain and inflammation. Studies have shown that PEA interactswith distinct non-CB1/CB2 receptors, suggesting that PEA utilizes aunique “parallel” endocannabinoid signaling system. This concept wasfurther supported by growing evidences that PEA production andinactivation can occur independently of AEA and 2-AG production andinactivation. Much of the biological effects of PEA on cells can beattributed to its affinity to PPAR (particularly PPAR-α and PPAR-γ). PEAwas shown to have an affinity to cannabinoid-like G-coupled receptorsGPR55 and GPR119 as well as the transient receptor potential vanilloidtype 1 receptor (TRPV1). PEA has been shown to have anti-inflammatory,anti-nociceptive, neuro-protective, and anti-convulsant properties.

First described by S. Ben-Shabat et al. (Eur. J. Pharmacol., 1998, Vol.353(1), pages 23-31), the concept of the “entourage effect” is thatplant cannabinoids act together, or possess synergy, and affect the bodyin a mechanism similar to the body's own endocannabinoid system. Thistheory serves as the foundation for a somewhat controversial idea withinpharmacology, that in certain cases whole plant extractions serve asbetter therapeutic agents than individual cannabinoid extractions. The“entourage effect” theory has been expanded in recent times by Wagnerand Ulrich-Merzenich (Phytomedicine, 2009, Vol. 16(2-3), pages 97-110),who define the four basic mechanisms of whole plant extract synergy asfollows: (a) ability to affect multiple targets within the body, (b)ability to improve the absorption of active ingredients, (c) ability toovercome bacterial defense mechanisms, and (d) ability to minimizeadverse side-effects.

There remains a need in the field of cannabinoid therapy forpharmaceutical combinations of cannabinoids and other agents capable ofincreasing the potency, decreasing the therapeutic dosages, reducing theside-effects and/or prolonging the therapeutic window of cannabinoids,particularly THC, in humans.

SUMMARY OF THE INVENTION

The present invention provides pharmaceutical compositions comprisingbeneficial combinations of cannabinoids and N-acylethanolamines Thesecombinations are defined, in part, by specific molar ratios between therespective active agents and/or by their dosages, and may be employed ina variety of methods. Particularly, the present invention providesmethods for preventing and/or treating a variety of conditionsresponsive to cannabinoid treatment such as movement disorders, forexample Tourette's syndrome and related symptoms. In addition, thepresent invention provides methods for preventing and/or treatingconditions associated with cannabinoid uptake, such as body-weight gain,confusion, disorientation and anxiety. Furthermore, the presentinvention provides methods for increasing the therapeutic effectassociated with cannabinoid uptake, such as prevention or ameliorationof pain.

The provision of such combinations provides great benefits over othercompositions and methods utilizing cannabinoids alone. For example, themethods provided herein potentiate the therapeutic effect of prescribedcannabinoids, which may be clinically translated to a more beneficialtherapeutic result or to the use of lower dosages of cannabinoids toobtain a predetermined therapeutic result. The methods provided hereinfurther advantageously eliminate or substantially minimize adverseside-effects commonly associated with cannabinoid uptake incannabis-prescribed patients. In other words, according to theprinciples of the present invention, the therapeutic window (orpharmaceutical window) of the cannabinoid, i.e. the range of cannabinoiddosages which can treat disease effectively without having toxiceffects, is expended by the combinations provided herein.

The present invention is based, in part, on the surprising findings thatcombinations of cannabinoids and N-acylethanolamines were able toprevent or ameliorate a variety of side-effects associated withcannabinoid consumption in an in-vivo model, and that these combinationswere further able to increase the effect of cannabinoids as analgesicagents. Without being bound to any theory or mechanism, it ishypothesized that co-administration of cannabinoids andN-acylethanolamines increases the potency of cannabinoids whiledecreasing their related side-effects, a phenomenon previously labeled“entourage effect”.

The present invention provides, in one aspect, a pharmaceuticalcomposition comprising a therapeutically-effective amount of a mixtureof at least one cannabinoid or a salt thereof and at least oneN-acylethanolamine or a salt thereof, wherein the molar ratio betweenthe cannabinoid and the N-acylethanolamine is between about 1:0.2 toabout 1:2000.

In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:0.2 to about 1:5. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:0.5 to about 1:2. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:15 to about 1:1800. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:25 to about 1:450. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:50 to about 1:100. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:50. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:100.Each possibility represents a separate embodiment of the presentinvention.

In certain embodiments, the pharmaceutical composition comprises about0.5-10 mg cannabinoid or a salt thereof. In certain embodiments, thepharmaceutical composition comprises about 1 mg, about 2.5 mg, about 5mg, or about 10 mg cannabinoid or a salt thereof. Each possibilityrepresents a separate embodiment of the present invention.

In certain embodiments, the at least one cannabinoid is selected fromtetrahydrocannabinol (THC), tetrahydrocannabinolic acid (THCA),cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG), cannabichromene(CBC), cannabicyclol (CBL), cannabivarin (CBV), tetrahydrocannabivarin(THCV), cannabidivarin (CBDV), cannabichromevarin (CBCV),cannabigerovarin (CBGV), cannabigerol monomethyl ether (CBGM), saltsthereof and any combination thereof. Each possibility represents aseparate embodiment of the present invention. In certain embodiments,the at least one cannabinoid is THC or a salt thereof. In certainembodiments, the cannabinoid consists of THC or a salt thereof. Incertain embodiments, cannabinoid consists of THC.

In certain embodiments, the pharmaceutical composition comprises about200-1800 mg N-acylethanolamine or a salt thereof. In certainembodiments, the pharmaceutical composition comprises about 250 mg,about 500 mg, about 750 mg, about 1000 mg or about 1500 mgN-acylethanolamine or a salt thereof. Each possibility represents aseparate embodiment of the present invention.

In certain embodiments, the N-acylethanolamine is selected from thegroup consisting of N-palmitoylethanolamine (PEA),Me-palmitoylethanolamide (Me-PEA), palmitoylcyclohexamide,palmitoylbutylamide, palmitoylisopropylamide, oleoylethanolamine (OEA),palmitoylisopropylamide (PIA), salts thereof and any combinationthereof. Each possibility represents a separate embodiment of thepresent invention. In certain embodiments, the N-acylethanolamine is PEAor a salt thereof. In certain embodiments, the N-acylethanolamineconsists of PEA or a salt thereof. In certain embodiments, theN-acylethanolamine consists of PEA.

In certain embodiments, the mixture comprises THC or a salt thereof andPEA or a salt thereof. In certain embodiments, the mixture consists ofTHC or a salt thereof and PEA or a salt thereof. In certain embodiments,the mixture comprises THC and PEA. In certain embodiments, the mixtureconsists of THC and PEA. In certain embodiments, the mixture comprisesabout 0.5-10 mg THC or a salt thereof and about 200-1800 mg PEA or asalt thereof. In certain embodiments, the mixture consists of THC andPEA. In certain embodiments, the mixture comprises about 2.5-10 mg THCor a salt thereof and about 250-1000 mg PEA or a salt thereof. Incertain embodiments, the mixture comprises about 2.5 mg, about 5 mg,about 7.5 mg or about 10 mg THC or a salt thereof and about 250 mg,about 500 mg, about 750 mg or about 1000 mg PEA or a salt thereof. Eachpossibility represents a separate embodiment of the present invention.

In certain embodiments, the pharmaceutical composition is formulated forsystemic administration. In certain embodiments, the pharmaceuticalcomposition is formulated for oral, oral mucosal, nasal, sublingual,inhalational, topical, rectal, vaginal, parenteral, intravenous,intramuscular, or subcutaneous administration. In certain embodiments,the pharmaceutical composition is formulated for oral, oral mucosal,nasal, or sublingual administration. Each possibility represents aseparate embodiment of the present invention. In certain embodiments,the pharmaceutical composition is formulated for oral administration. Incertain embodiments, the pharmaceutical composition is formulated fororal mucosal administration. In certain embodiments, the pharmaceuticalcomposition is formulated for nasal administration. In certainembodiments, the pharmaceutical composition is formulated for sublingualadministration.

The present invention further provides, in another aspect, a dosage unitcomprising or consisting of the pharmaceutical composition describedabove.

In certain embodiments, the dosage unit comprises the pharmaceuticalcomposition described above. In certain embodiments, the dosage unitconsisting of the pharmaceutical composition described above. In certainembodiments, the dosage unit is formulated as a gel, a powder or aspray. In certain embodiments, the dosage unit is formulated as a gel.In certain embodiments, the dosage unit is formulated as a powder. Incertain embodiments, the dosage unit is formulated as a spray.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating a condition amenable toprevention or treatment by at least one cannabinoid.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating at least one symptom of Tourettesyndrome.

In certain embodiments, the Tourette syndrome is classified as mildTourette syndrome. In certain embodiments, the Tourette syndrome isclassified as moderate Tourette syndrome. In certain embodiments, theTourette syndrome is classified as severe Tourette syndrome. In certainembodiments, the Tourette syndrome is classified as a moderate to severeTourette syndrome. In certain embodiments, the symptom is tics. Incertain embodiments, the tics are motor tics. In certain embodiments,the tics are phonic tics. In certain embodiments, the tics are verbaltics. In certain embodiments, the tics are vocal tics. In certainembodiments, the tics are simple motor tics. In certain embodiments, thetics are complex motor tics. In certain embodiments, the tics are simplephonic tics. In certain embodiments, the tics are complex phonic tics.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating pain.

In certain embodiments, the pain is an acute pain. In certainembodiments, the pain is chronic pain. In certain embodiments, the painis neuropathic pain.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating emesis.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating at least one side-effectassociated with cannabinoid consumption.

In certain embodiments, the side-effect is increased appetite. Incertain embodiments, the side-effect is body-weight gain. In certainembodiments, the side-effect is increased appetite and body-weight gain.In certain embodiments, the side-effect is confusion. In certainembodiments, the side-effect is disorientation. In certain embodiments,the side-effect is confusion and disorientation. In certain embodiments,the side-effect is anxiety.

In certain embodiments, the condition is amenable to prevention ortreatment by THC or a salt thereof In certain embodiments, theside-effect is associated with THC consumption.

In certain embodiments, the N-acylethanolamine increases the therapeuticpotency of the cannabinoid compared to the same pharmaceuticalcomposition without the N-acylethanolamine. In certain embodiments, theN-acylethanolamine decreases the required therapeutic dosage of thecannabinoid compared to the same pharmaceutical composition without theN-acylethanolamine. In certain embodiments, the N-acylethanolaminereduces at least one of the side-effects of the cannabinoid compared tothe same pharmaceutical composition without the N-acylethanolamine. Incertain embodiments, the N-acylethanolamine expends the therapeuticwindow of the cannabinoid compared to the same pharmaceuticalcomposition without the N-acylethanolamine In certain embodiments, thePEA or salt thereof increases the therapeutic potency of the THC or saltthereof compared to the same pharmaceutical composition without the PEAor salt thereof. In certain embodiments, the PEA or salt thereofdecreases the required therapeutic dosage of the THC or salt thereofcompared to the same pharmaceutical composition without the PEA or saltthereof. In certain embodiments, the PEA or salt thereof reduces atleast one of the side-effects of the THC or salt thereof compared to thesame pharmaceutical composition without the PEA or salt thereof. Incertain embodiments, the PEA or salt thereof expends the therapeuticwindow of the THC or salt thereof compared to the same pharmaceuticalcomposition without the PEA or salt thereof.

The present invention further provides, in another aspect, a method forpreventing or treating a condition amenable to prevention or treatmentby at least one cannabinoid in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating the condition.

The present invention further provides, in another aspect, a method forpreventing or treating at least one symptom of Tourette syndrome in ahuman subject in need thereof, the method comprising the step ofadministering to the subject a therapeutically-effective amount of acombination of a pharmaceutical composition comprising at least onecannabinoid or a salt thereof and a pharmaceutical compositioncomprising at least one N-acylethanolamine or a salt thereof, whereinthe molar ratio between the administered cannabinoid andN-acylethanolamine is between about 1:0.2 to about 1:2000, therebypreventing or treating the at least one symptom of Tourette syndrome.

The present invention further provides, in another aspect, a method forpreventing or treating pain in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating pain.

The present invention further provides, in another aspect, a method forpreventing or treating emesis in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating emesis.

The present invention further provides, in another aspect, a method forpreventing or treating at least one side-effect associated withcannabinoid consumption in a human subject in need thereof, the methodcomprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating the at least one side-effect.

In certain embodiments of the methods described above, the cannabinoidand the N-acylethanolamine are comprised in the same pharmaceuticalcomposition. In certain embodiments of the methods described above, thecannabinoid and the N-acylethanolamine are comprised in differentpharmaceutical compositions.

In certain embodiments of the methods described above, theadministration of the cannabinoid and the N-acylethanolamine is repeatedthree times a day. In certain embodiments of the methods describedabove, the administration of the cannabinoid and the N-acylethanolamineis repeated twice a day. In certain embodiments of the methods describedabove, the administration of the cannabinoid and the N-acylethanolamineis repeated once a day. In certain embodiments of the methods describedabove, the administration of the cannabinoid and the N-acylethanolamineis repeated once every two days. In certain embodiments of the methodsdescribed above, the administration of the cannabinoid and theN-acylethanolamine is repeated once every three days.

In certain embodiments of the methods described above, theadministration of the cannabinoid and the N-acylethanolamine is repeateduntil achieving a beneficial change in the condition of the subjectaccording to the Yale Global Tic Severity Scale (YGTSS) compared to hiscondition prior to treatment. In certain embodiments of the methodsdescribed above, the administration of the cannabinoid and theN-acylethanolamine is repeated until achieving a beneficial change inthe condition of the subject according to at least one scale selectedfrom the group consisting of (i) the Clinician Global Impression scale(CGIS), (ii) the Gilles de la Tourette Syndrome-Quality Of Life scale(GTS-QOL) (iii) the Tourette Syndrome Symptom List (TSSL) (iv) theYale-Brown Obsessive Compulsive Scale (Y-BOCS) (v) the ADHD RatingScale-IV (ADHD-RS) and (vi) the Hamilton Anxiety Rating Scale (HAM-A),compared to his condition prior to treatment. Each possibilityrepresents a separate embodiment of the present invention.

Further embodiments and the full scope of applicability of the presentinvention will become apparent from the detailed description givenhereinafter. However, it should be understood that the detaileddescription and specific examples, while indicating preferredembodiments of the invention, are given by way of illustration only,since various changes and modifications within the spirit and scope ofthe invention will become apparent to those skilled in the art from thisdetailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B are bar graphs illustrating different group averages ofbody weight gain during the study.

FIG. 2 is a bar graph illustrating different group averages of animalvelocity during evaluation in an open field test.

FIG. 3 is a bar graph illustrating different group averages of totaltime spent in the center of an arena during evaluation in an open fieldtest.

FIGS. 4A and 4B are bar graphs illustrating different group averages oflatency to respond in a tail pinch test.

DETAILED DESCRIPTION OF THE INVENTION

Cannabis has been used for medical purposes in many cultures forhundreds of years, in particular, for the treatment of pain, spasms,asthma, insomnia, depression and loss of appetite. In the 1960s, theexact chemical structure of delta-9-tetrahydrocannabinol (THC), the mainpsychoactive ingredient of cannabis sativa, has been be determined.Research on the medical use of cannabinoids was further stimulated whenit became clear that cannabinoids act through specific receptors: CB1receptors predominantly located in the central nervous system and CB2receptors that are expressed primarily by immune tissues. Today, in manycountries the cannabinoid THC and the cannabis extract nabiximolscontaining THC and CBD are approved for clinical use for the treatmentof nausea and vomiting associated with cancer chemotherapy, anorexia inHIV/AIDS, and spasticity in multiple sclerosis. There is substantialevidence that cannabinoids are also effective in the treatment of otherconditions such as neuropathic pain, spasms and movement disorders(Muller-Vahl K R, Behavioural Neurology, 2013, 27, 119-124). However, ithas also been found in controlled clinical trials that while higherdosages of THC (7.5-10 mg/day) are more effective than lower dosages(Muller-Vahl K R et al., Pharmacopsychiatry, 2002; 35(2): 57-61), someof the patients were unable to tolerate the maximum dose, and THC uptakewas reduced by up to 5.0 mg/day until a tolerated dose was achieved(Muller-Vahl K R et al, J. Clin. Psychiatry, 2003; 64(4): 459-65).

The pharmaceutical combinations provided by the present invention, inwhich cannabinoids are combined with N-acylethanolamines, eliminate thisinherent, adverse dichotomy between therapeutic efficacy andtolerability by potentiating the therapeutic effect of prescribedcannabinoids, which is clinically translated to a more beneficialtherapeutic result or to the use of lower dosages of cannabinoids toobtain a predetermined therapeutic result. The pharmaceuticalcombinations provided by the present invention further advantageouslyeliminate or substantially minimize adverse side-effects commonlyassociated with cannabinoid uptake in cannabis-prescribed patients.According to the principles of the present invention, the therapeuticwindow of the cannabinoids is expended by the pharmaceuticalcombinations provided herein such that (a) standard THC dosages, e.g. inthe range of 5-10 mg THC daily are better tolerated due to reducedside-effects, and (b) standard THC dosages can be markedly reducedwithout compromising their therapeutic efficacy or the patient's healthdue to the increased efficacy of THC.

The present invention discloses that N-acylethanolamine compoundsexhibit a cannabinoid-sparing effect. The term “cannabinoid-sparing” asused herein refers to the enablement of the use of low dosages ofcannabinoids in instances wherein a mid- or high-dosages of cannabinoidsare typically required. The cannabinoid and N-acylethanolamine compoundsaccording to the present invention include pharmaceutically acceptableforms thereof, including isomers such as diastereomers and enantiomers,salts, solvates, and polymorphs, as well as racemic mixtures.

The present invention provides, in one aspect, a pharmaceuticalcomposition comprising a therapeutically-effective amount of a mixtureof at least one cannabinoid or a salt thereof and at least oneN-acylethanolamine or a salt thereof.

The present invention provides, in another aspect, a pharmaceuticalcomposition comprising a therapeutically-effective amount of a mixtureof at least one cannabinoid or a salt thereof and at least oneN-acylethanolamine or a salt thereof, wherein the molar ratio betweenthe cannabinoid and the N-acylethanolamine is between about 1:0.2 toabout 1:2000.

As used herein, a “pharmaceutical composition” refers to a preparationof the active agents described herein with other chemical componentssuch as physiologically suitable carriers and excipients. The purpose ofa pharmaceutical composition is to facilitate administration of acompound to an organism. As used herein, the phrase “pharmaceuticallyacceptable carrier” refers to a carrier, an excipient or a diluent thatdoes not cause significant irritation to an organism and does notabrogate the biological activity and properties of the administeredcompound. An adjuvant is included under these phrases.

The term “excipient” as used herein refers to an inert substance addedto a pharmaceutical composition to further facilitate administration ofan active ingredient. Examples, without limitation, of excipientsinclude calcium carbonate, calcium phosphate, various sugars and typesof starch, cellulose derivatives, gelatin, oils such as vegetable oilsor fish oils, and polyethylene glycols.

The term “carrier” as used herein refers to a diluent, adjuvant,excipient, or vehicle with which the compound is administered. Suchpharmaceutical carriers can be sterile liquids, such as water and oils.Water or aqueous solution saline solutions and aqueous dextrose andglycerol solutions are preferably employed as carriers, particularly forinjectable solutions. Suitable pharmaceutical carriers are described in“Remington's Pharmaceutical Sciences” by E. W. Martin, 18th Edition.

The phrase “pharmaceutically acceptable” as used herein refers tomolecular entities and compositions that are physiologically tolerableand do not typically produce an allergic or similar toxicity whenadministered to an individual. Preferably, and particularly where aformulation is used in humans, the term “pharmaceutically acceptable”may mean approved by a regulatory agency (for example, the U.S. Food andDrug Agency) or listed in a generally recognized pharmacopeia for use inanimals (e.g., the U.S. Pharmacopeia).

The term “cannabinoid” as used herein generally refers to a class ofdiverse chemical compounds that act on cannabinoid receptors on cellsthat repress neurotransmitter release in the brain. Ligands for thesereceptor proteins include the endocannabinoids (produced naturally inthe body by humans and animals), the phytocannabinoids (found incannabis and some other plants), and synthetic cannabinoids(manufactured artificially). There are at least 85 differentcannabinoids isolated from cannabis, exhibiting varied effects (El-Alfyet al., Pharmacology Biochemistry and Behavior, 2010, Vol. 95(4), pages434-442).

The term “N-acylethanolamine” as used herein generally refers to a typeof fatty acid amide, lipid-derived signaling molecules, formed when oneof several types of acyl group is linked to the nitrogen atom ofethanolamine. These amides conceptually can be formed from a fatty acidand ethanolamine with the release of a molecule of water, but the knownbiological synthesis uses a specific phospholipase D to cleave thephospholipid unit from N-acylphosphatidylethanolamines. The suffixes-amine and -amide in these names each refer to the single nitrogen atomof ethanolamine that links the compound together: it is termed “amine”in ethanolamine because it is considered as a free terminal nitrogen inthat subunit, while it is termed “amide” when it is considered inassociation with the adjacent carbonyl group of the acyl subunit. Namesfor these compounds may be encountered with either “amide” or “amine” inthe present application. The term “ethanolamine” is used in the genericsense and is meant to include mono-ethanolamine, di-ethanolamine,tri-ethanolamine, and mixtures thereof.

The term “derivative” as used herein means a compound whose corestructure is the same as, or closely resembles that of anN-acylethanolamine compound, but which has a chemical or physicalmodification, such as different or additional side groups.

The term “salt” as used herein refers to any form of an activeingredient in which the active ingredient assumes an ionic form and iscoupled to a counter ion (a cation or anion) or is in solution. Thisalso includes complexes of the active ingredient with other moleculesand ions, in particular complexes which are complexed by ioninteraction.

In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:0.2 to about 1:5. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:0.22 to about 1:4.5, about 1:0.25to about 1:4, between about 1:0.28 to about 1:3.5, between about 1:0.33to about 1:3, between about 1:0.4 to about 1:2.5, between about 1:0.5 toabout 1:2 or about 1:1. Each possibility represents a separateembodiment of the present invention.

In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:15 to about 1:1800. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:16 to about 1:1700, about 1:17 toabout 1:1600, about 1:18 to about 1:1500, about 1:19 to about 1:1400,about 1:20 to about 1:1300, about 1:21 to about 1:1200, about 1:22 toabout 1:1100, about 1:23 to about 1:1000, about 1:24 to about 1:900,about 1:15 to about 1:800, about 1:16 to about 1:700, about 1:17 toabout 1:600, about 1:18 to about 1:500, about 1:19 to about 1:490, about1:20 to about 1:480, about 1:21 to about 1:470, or about 1:22 to about1:460. Each possibility represents a separate embodiment of the presentinvention. In certain embodiments, the molar ratio between thecannabinoid and the N-acylethanolamine is between about 1:25 to about1:450. In certain embodiments, the molar ratio between the cannabinoidand the N-acylethanolamine is between about 1:10 to about 1:500, about1:15 to about 1:450, about 1:20 to about 1:400, about 1:25 to about1:350, about 1:30 to about 1:300, about 1:35 to about 1:250, about 1:40to about 1:200, or about 1:45 to about 1:150. Each possibilityrepresents a separate embodiment of the present invention. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is between about 1:50 to about 1:100. In certainembodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:10. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:20.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:30. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:40.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:50. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:60.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:70. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:80.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:90. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:100.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:110. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:120.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:130. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:140.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:150. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:160.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:170. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:180.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is about 1:190. In certain embodiments, the molarratio between the cannabinoid and the N-acylethanolamine is about 1:200.In certain embodiments, the molar ratio between the cannabinoid and theN-acylethanolamine is at least about 1:10, at least about 1:20, at leastabout 1:30, at least about 1:40, at least about 1:50, at least about1:60, at least about 1:70, at least about 1:80, at least about 1:90, orat least about 1:100. Each possibility represents a separate embodimentof the present invention.

In certain embodiments, the pharmaceutical composition comprises about0.5-10 mg cannabinoid or a salt thereof. In certain embodiments, thepharmaceutical composition comprises about 1-9.5 mg, about 1.5-9 mg,about 2-8.5 mg, about 2.5-8 mg, about 3-7.5 mg, about 3.5-7 mg, about4-6.5 mg, about 4.5-6 mg or about 5-5.5 mg cannabinoid or a saltthereof. In certain embodiments, the pharmaceutical compositioncomprises about 0.5 mg, about 1 mg, about 1.5 mg, about 2 mg, about 2.5mg, about 3 mg, about 3.5 mg, about 4 mg, about 4.5 mg, about 5 mg,about 5.5 mg, about 6 mg, about 6.5 mg, about 7 mg, about 7.5 mg, about8 mg, about 8.5 mg, about 9 mg, about 9.5 mg or about 10 mg cannabinoidor a salt thereof. Each possibility represents a separate embodiment ofthe present invention. In certain embodiments, the pharmaceuticalcomposition comprises less than about 0.5 mg, less than about 1 mg, lessthan about 1.5 mg, less than about 2 mg, less than about 2.5 mg, lessthan about 3 mg, less than about 3.5 mg, less than about 4 mg, less thanabout 4.5 mg, less than about 5 mg, less than about 5.5 mg, less thanabout 6 mg, less than about 6.5 mg, less than about 7 mg, less thanabout 7.5 mg, less than about 8 mg, less than about 8.5 mg, less thanabout 9 mg, less than about 9.5 mg or about 10 mg cannabinoid or a saltthereof. Each possibility represents a separate embodiment of thepresent invention. In certain embodiments, the pharmaceuticalcomposition comprises about 0.5 mg to about 1 mg, about 0.5 mg to about1.5 mg, about 0.5 mg to about 2 mg, about 0.5 mg to about 2.5 mg, about0.5 mg to about 3 mg, about 0.5 mg to about 3.5 mg, about 0.5 mg toabout 4 mg, about 0.5 mg to about 4.5 mg, about 0.5 mg to about 5 mg,about 0.5 mg to about 5.5 mg, about 0.5 mg to about 6 mg, about 0.5 mgto about 6.5 mg, about 0.5 mg to about 7 mg, about 0.5 mg to about 7.5mg, about 0.5 mg to about 8 mg, about 0.5 mg to about 8.5 mg, about 0.5mg to about 9 mg or about 0.5 mg to about 9.5 mg cannabinoid or a saltthereof. Each possibility represents a separate embodiment of thepresent invention.

In certain embodiments, the at least one cannabinoid is selected fromtetrahydrocannabinol (THC), tetrahydrocannabinolic acid (THCA),cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG), cannabichromene(CBC), cannabicyclol (CBL), cannabivarin (CBV), tetrahydrocannabivarin(THCV), cannabidivarin (CBDV), cannabichromevarin (CBCV),cannabigerovarin (CBGV), cannabigerol monomethyl ether (CBGM), saltsthereof and any combination thereof. Each possibility represents aseparate embodiment of the present invention. In certain embodiments,the at least one cannabinoid is THC or a salt thereof and CBD or a saltthereof. In certain embodiments, the at least one cannabinoid consistsof THC or a salt thereof and CBD or a salt thereof. In certainembodiments, the molar ratio between the THC or salt thereof and the CBDor salt thereof is between about 2:1 to about 1:2. In certainembodiments, the molar ratio between the THC or salt thereof and the CBDor salt thereof is about 1:1. In certain embodiments, the at least onecannabinoid is THC or a salt thereof. In certain embodiments, the atleast one cannabinoid consists of THC or a salt thereof. In certainembodiments, the at least one cannabinoid consists of THC.

In certain embodiments, the pharmaceutical composition comprises about200-1800 mg N-acylethanolamine or a salt thereof. In certainembodiments, the pharmaceutical composition comprises about 250-1550 mg,about 300-1200 mg, about 350-950 mg, about 400-700 mg, about 450-600 mgor about 500-550 mg N-acylethanolamine or a salt thereof. Eachpossibility represents a separate embodiment of the present invention.In certain embodiments, the pharmaceutical composition comprises atleast about 50 mg, at least about 100 mg, at least about 150 mg, atleast about 200 mg, at least about 250 mg, at least about 300 mg, atleast about 350 mg, at least about 400, at least about 450 mg, at leastabout 500 mg, at least about 550 mg, at least about 600 mg, at leastabout 650 mg, at least about 700 mg, at least about 750 mg, at leastabout 800 mg, at least about 850 mg, at least about 900 mg, at leastabout 950 mg, at least about 1000 mg, at least about 1050 mg, at leastabout 1100 mg, at least about 1150 mg, at least about 1200 mg, at leastabout 1250 mg, at least about 1300 mg, at least about 1350 mg, at leastabout 1400 mg, at least about 1450 mg, at least about 1500 mg, at leastabout 1550 mg, at least about 1600 mg, at least about 1650 mg, at leastabout 1700 mg, at least about 1750 mg or at least about 1800 mgN-acylethanolamine or a salt thereof. In certain embodiments, thepharmaceutical composition comprises about 50 mg, about 100 mg, about150 mg, about 200 mg, about 250 mg, about 300 mg, about 350 mg, about400, about 450 mg, about 500 mg, about 550 mg, about 600 mg, about 650mg, about 700 mg, about 750 mg, about 800 mg, about 850 mg, about 900mg, about 950 mg, about 1000 mg, about 1050 mg, about 1100 mg, about1150 mg, about 1200 mg, about 1250 mg, about 1300 mg, about 1350 mg,about 1400 mg, about 1450 mg, about 1500 mg, about 1550 mg, about 1600mg, about 1650 mg, about 1700 mg, about 1750 mg or about 1800 mgN-acylethanolamine or a salt thereof. Each possibility represents aseparate embodiment of the present invention.

In certain embodiments, the N-acylethanolamine is selected from thegroup consisting of N-palmitoylethanolamine (PEA),Me-palmitoylethanolamide (Me-PEA), palmitoylcyclohexamide,palmitoylbutyl amide, palmitoylisopropylamide, oleoylethanolamine (OEA),palmitoylisopropylamide (PIA), salts thereof and any combinationthereof. Each possibility represents a separate embodiment of thepresent invention. In certain embodiments, the N-acylethanolamine is PEAor a salt thereof. In certain embodiments, the N-acylethanolamineconsists of PEA or a salt thereof. In certain embodiments, theN-acylethanolamine consists of PEA.

In certain embodiments, the mixture comprises THC or a salt thereof andPEA or a salt thereof. In certain embodiments, the mixture consists ofTHC or a salt thereof and PEA or a salt thereof. In certain embodiments,the mixture comprises THC and PEA. In certain embodiments, the mixtureconsists of THC and PEA. In certain embodiments, the mixture comprisesabout 1-9.5 mg, about 1.5-9 mg, about 2-8.5 mg, about 2.5-8 mg, about3-7.5 mg, about 3.5-7 mg, about 4-6.5 mg, about 4.5-6 mg or about 5-5.5mg THC or a salt thereof and about 250-1550 mg, about 300-1200 mg, about350-950 mg, about 400-700 mg, about 450-600 mg or about 500-550 mg PEAor a salt thereof. In certain embodiments, the mixture comprises about0.5 mg, about 1 mg, about 1.5 mg, about 2 mg, about 2.5 mg, about 3 mg,about 3.5 mg, about 4 mg, about 4.5 mg, about 5 mg, about 5.5 mg, about6 mg, about 6.5 mg, about 7 mg, about 7.5 mg, about 8 mg, about 8.5 mg,about 9 mg, about 9.5 mg or about 10 mg THC or a salt thereof and atleast about 50 mg, at least about 100 mg, at least about 150 mg, atleast about 200 mg, at least about 250 mg, at least about 300 mg, atleast about 350 mg, at least about 400, at least about 450 mg, at leastabout 500 mg, at least about 550 mg, at least about 600 mg, at leastabout 650 mg, at least about 700 mg, at least about 750 mg, at leastabout 800 mg, at least about 850 mg, at least about 900 mg, at leastabout 950 mg, at least about 1000 mg, at least about 1050 mg, at leastabout 1100 mg, at least about 1150 mg, at least about 1200 mg, at leastabout 1250 mg, at least about 1300 mg, at least about 1350 mg, at leastabout 1400 mg, at least about 1450 mg, at least about 1500 mg, at leastabout 1550 mg, at least about 1600 mg, at least about 1650 mg, at leastabout 1700 mg, at least about 1750 mg or at least about 1800 mg PEA or asalt thereof. In certain embodiments, the mixture comprises about 0.5mg, about 1 mg, about 1.5 mg, about 2 mg, about 2.5 mg, about 3 mg,about 3.5 mg, about 4 mg, about 4.5 mg, about 5 mg, about 5.5 mg, about6 mg, about 6.5 mg, about 7 mg, about 7.5 mg, about 8 mg, about 8.5 mg,about 9 mg, about 9.5 mg or 10 about mg THC or a salt thereof and about50 mg, about 100 mg, about 150 mg, about 200 mg, about 250 mg, about 300mg, about 350 mg, about 400, about 450 mg, about 500 mg, about 550 mg,about 600 mg, about 650 mg, about 700 mg, about 750 mg, about 800 mg,about 850 mg, about 900 mg, about 950 mg, about 1000 mg, about 1050 mg,about 1100 mg, about 1150 mg, about 1200 mg, about 1250 mg, about 1300mg, about 1350 mg, about 1400 mg, about 1450 mg, about 1500 mg, about1550 mg, about 1600 mg, about 1650 mg, about 1700 mg, about 1750 mg orabout 1800 mg PEA or a salt thereof. In certain embodiments, the mixturecomprises about 0.5-10 mg THC or a salt thereof and about 200-1800 mgPEA or a salt thereof. In certain embodiments, the mixture comprisesabout 2.5-10 mg THC or a salt thereof and about 250-1000 mg PEA or asalt thereof. In certain embodiments, the mixture comprises about 2.5mg, about 5 mg, about 7.5 mg or about 10 mg THC or a salt thereof andabout 250 mg, about 500 mg, about 750 mg or about 1000 mg PEA or a saltthereof. Each possibility represents a separate embodiment of thepresent invention.

In certain embodiments, the pharmaceutical composition is formulated forsystemic administration. In certain embodiments, the pharmaceuticalcomposition is formulated for oral, oral mucosal, nasal, sublingual,inhalational, topical, rectal, vaginal, parenteral, intravenous,intramuscular, or subcutaneous administration. In certain embodiments,the pharmaceutical composition is formulated for oral, oral mucosal,nasal, or sublingual administration. Each possibility represents aseparate embodiment of the present invention. In certain embodiments,the pharmaceutical composition is formulated for oral administration. Incertain embodiments, the pharmaceutical composition is formulated fororal mucosal administration. In certain embodiments, the pharmaceuticalcomposition is formulated for nasal administration. In certainembodiments, the pharmaceutical composition is formulated for sublingualadministration.

Techniques for formulation and administration of drugs are well known inthe art, and may be found, e.g. in “Remington's PharmaceuticalSciences,” Mack Publishing Co., Easton, Pa. Pharmaceutical compositionsof the present invention may be manufactured by processes well known inthe art, e.g., by means of conventional mixing, dissolving, granulating,dragee-making, levigating, emulsifying, encapsulating, entrapping, orlyophilizing processes.

For oral administration, the pharmaceutical composition can beformulated readily by combining the active compounds withpharmaceutically acceptable carriers well known in the art. Suchcarriers enable the pharmaceutical composition to be formulated astablets, pills, dragees, capsules, liquids, gels, syrups, slurries,suspensions, and the like, for oral ingestion by a patient.Pharmacological preparations for oral use can be made using a solidexcipient, optionally grinding the resulting mixture, and processing themixture of granules, after adding suitable auxiliaries as desired, toobtain tablets or dragee cores. Suitable excipients are, in particular,fillers such as sugars, including lactose, sucrose, mannitol, orsorbitol; cellulose preparations such as, for example, maize starch,wheat starch, rice starch, potato starch, gelatin, gum tragacanth,methyl cellulose, hydroxypropylmethyl-cellulose, and sodiumcarbomethylcellulose; and/or physiologically acceptable polymers such aspolyvinylpyrrolidone (PVP). If desired, disintegrating agents, such ascross-linked polyvinyl pyrrolidone, agar, or alginic acid or a saltthereof, such as sodium alginate, may be added.

The term “oral administration” refers to any method of administration inwhich an active agent can be administered by swallowing, chewing,sucking, or drinking an oral dosage form. Examples of solid dosage formsinclude conventional tablets, multi-layer tablets, capsules, caplets,etc., which do not substantially release the drug in the mouth or in theoral cavity.

Dragee cores are provided with suitable coatings. For this purpose,concentrated sugar solutions may be used which may optionally containgum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethyleneglycol, titanium dioxide, lacquer solutions, and suitable organicsolvents or solvent mixtures. Dyestuffs or pigments may be added to thetablets or dragee coatings for identification or to characterizedifferent combinations of active compound doses.

Pharmaceutical compositions that can be used orally include stiff orsoft, sealed capsules made of gelatin and a plasticizer, such asglycerol or sorbitol. The capsules may contain the active ingredients inadmixture with filler such as lactose, binders such as starches,lubricants such as talc or magnesium stearate, and, optionally,stabilizers. In soft capsules, the active ingredients may be dissolvedor suspended in suitable liquids, such as fatty oils, liquid paraffin,or liquid polyethylene glycols. In addition, stabilizers may be added.All formulations for oral administration should be in dosages suitablefor the chosen route of administration. For buccal and sublingualadministration, the compositions may take the form of tablets orlozenges formulated in conventional manner or in adhesive carriers.

Alternatively, the active ingredient may be in powder form forconstitution with a suitable vehicle, e.g., a sterile, pyrogen-free,water-based solution, before use.

Pharmaceutical compositions suitable for use in the context of thepresent invention include compositions wherein the active ingredientsare contained in an amount effective to achieve the intended purpose.More specifically, a “therapeutically effective amount” means an amountof active ingredients effective to prevent, alleviate, or amelioratesymptoms or side effects of a disease or disorder, or prolong thesurvival of the subject being treated.

Determination of a therapeutically effective amount is well within thecapability of those skilled in the art, especially in light of thedetailed disclosure provided herein. More specifically, a“therapeutically effective amount of a mixture” means an amount of atleast two active ingredients, wherein each one of the active ingredientsindependently may not be in a therapeutically effective amount orwherein both of the active ingredients may not be in a therapeuticallyeffective amount, the mixture is nevertheless effective to prevent,alleviate, or ameliorate symptoms or side effects of a disease ordisorder, or prolong the survival of the subject being treated. The term“mixture” as used herein refers to a non-covalent combination of twomolecules.

For any preparation used in the methods of the invention, the dosage orthe therapeutically effective amount can be estimated initially from invitro, in vivo and cell culture assays. For example, a dose can beformulated in animal models to achieve a desired concentration or titer.Such information can be used to more accurately determine useful dosesin humans. The dosage of each compound of the claimed combinationsdepends on several factors, including: the administration method, thedisease to be treated, the severity of the disease, whether the diseaseis to be treated or prevented, and the age, weight, and health of theperson to be treated. Additionally, pharmacogenomic (the effect ofgenotype on the pharmacokinetic, pharmacodynamic or efficacy profile ofa therapeutic) information about a particular patient may affect dosageused. Continuous daily dosing may not be required; a therapeutic regimenmay require cycles, during which time a drug is not administered, ortherapy may be provided on an as-needed basis during periods of acutedisease worsening. Dosage escalation may or may not be required; atherapeutic regimen may require reduction in medication dosage. Toxicityand therapeutic efficacy of the active ingredients described herein canbe determined by standard pharmaceutical procedures in vitro, in cellcultures or experimental animals. The data obtained from these in vitroand cell culture assays and animal studies can be used in formulating arange of dosage for use in human. The dosage may vary depending upon thedosage form employed and the route of administration utilized. The exactformulation, route of administration, and dosage can be chosen by theindividual physician in view of the patient's condition (See, e.g.,Fingl, E. et al. (1975), “The Pharmacological Basis of Therapeutics,”Ch. 1, p. 1). Depending on the severity and responsiveness of thecondition to be treated, dosing can be of a single or a plurality ofadministrations, with course of treatment lasting from several days toseveral weeks, or until cure is effected or diminution of the diseasestate is achieved.

The present invention further provides, in another aspect, a dosage unitcomprising or consisting of the pharmaceutical composition describedabove.

In certain embodiments, the dosage unit comprises the pharmaceuticalcomposition described above. In certain embodiments, the dosage unitconsisting of the pharmaceutical composition described above. In certainembodiments, the dosage unit is formulated as a gel, a powder or aspray. In certain embodiments, the dosage unit is formulated as a gel.In certain embodiments, the dosage unit is formulated as a powder. Incertain embodiments, the dosage unit is formulated as a spray.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating a condition amenable toprevention or treatment by at least one cannabinoid.

In certain embodiments, the pharmaceutical composition or a dosage unitas described above for use in a method for preventing or treating acondition amenable to prevention or treatment by at least onecannabinoid comprises the cannabinoid and the N-acylethanolamine in amolar ratio between about 1:15 to about 1:1800.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating at least one symptom of amovement disorder.

In certain embodiments, the pharmaceutical composition or a dosage unitas described above for use in a method for preventing or treating atleast one symptom of at least one symptom of a movement disordercomprises the cannabinoid and the N-acylethanolamine in a molar ratiobetween about 1:15 to about 1:1800.

In certain embodiments, the movement disorder is selected from Ticdisorders, Tourette's syndrome, Parkinson's disease Hallevorden-Spatzdisease, progressive supranuclear ophthalmoplegia, striatonigraldeneneration, dystonia, spasmodic torticolis, blepharospasm, tremor,myoclonus, chorea, ballismus, hemiballismus, athetosis, dyskinesia,paroxysmal nocturnal limb movement, moving toes or fingers syndrome,restless leg syndrome, Stiff-person syndrome, abnormal head movements,cramp, spasm, and Fasciculation.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating at least one symptom of Tourettesyndrome.

The term “treating” as used herein, includes, but is not limited to, anyone or more of the following: abrogating, ameliorating, inhibiting,attenuating, blocking, suppressing, reducing, delaying, halting,alleviating or preventing one or more symptoms or side effects of thediseases or conditions of the invention.

The term “acute” refers to a condition with a relatively short, severecourse.

The term “chronic” as used herein means that the length of time of thediseases or conditions of the invention can be weeks, months, orpossibly years. The intensity of the diseases or conditions candifferentiate according to various conditions such as patient age,temperature, season, type of disease, etc.

In certain embodiments, the pharmaceutical composition or a dosage unitas described above for use in a method for preventing or treating atleast one symptom of Tourette syndrome comprises the cannabinoid and theN-acylethanolamine in a molar ratio between about 1:15 to about 1:1800.

In certain embodiments, the Tourette syndrome is classified as mildTourette syndrome. In certain embodiments, the Tourette syndrome isclassified as moderate Tourette syndrome. In certain embodiments, theTourette syndrome is classified as severe Tourette syndrome. In certainembodiments, the Tourette syndrome is classified as a moderate to severeTourette syndrome. In certain embodiments, the symptom is tics. Incertain embodiments, the tics are motor tics. In certain embodiments,the tics are phonic tics. In certain embodiments, the tics are verbaltics. In certain embodiments, the tics are vocal tics.

In certain embodiments, the tics are simple motor tics. In certainembodiments, the tics are complex motor tics. In certain embodiments,the tics are simple phonic tics. In certain embodiments, the tics arecomplex phonic tics.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating pain.

In certain embodiments, the pharmaceutical composition or a dosage unitas described above for use in a method for preventing or treating paincomprises the cannabinoid and the N-acylethanolamine in a molar ratiobetween about 1:0.2 to about 1:5.

Neuropathic pain is a localized sensation of unpleasant discomfortcaused by damage or disease that affects the somatosensory system. TheInternational Association for the Study of Pain (IASP) widely useddefinition of pain states: “Pain is an unpleasant sensory and emotionalexperience associated with actual or potential tissue damage, ordescribed in terms of such damage”. Therefore, the term “pain”, as usedherein, means an unpleasant sensory and emotional experience associatedwith actual or potential tissue damage, or described in terms of suchdamage. Neuropathic pain may be associated with abnormal sensationscalled dysesthesia, and pain from normally non-painful stimuli(allodynia). It may have continuous and/or episodic (paroxysmal)components. The latter resemble stabbings or electric shocks. Commonqualities include burning or coldness, “pins and needles” sensations,numbness and itching. Nociceptive pain, by contrast, is more commonlydescribed as aching. Central neuropathic pain is found in spinal cordinjury, multiple sclerosis, and some strokes. Aside from diabetes andother metabolic conditions, the common causes of painful peripheralneuropathies are herpes zoster infection, HIV-related neuropathies,nutritional deficiencies, toxins, remote manifestations of malignancies,immune mediated disorders and physical trauma to a nerve trunk.Neuropathic pain is common in cancer as a direct result of cancer onperipheral nerves (e.g., compression by a tumor), or as a side effect ofchemotherapy (chemotherapy-induced peripheral neuropathy), radiationinjury or surgery.

In certain embodiments, the pain is an acute pain. In certainembodiments, the pain is chronic pain. In certain embodiments, the painis neuropathic pain.

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating emesis.

In certain embodiments, the pharmaceutical composition or a dosage unitas described above for use in a method for preventing or treating emesiscomprises the cannabinoid and the N-acylethanolamine in a molar ratiobetween about 1:15 to about 1:1800.

In certain embodiments, the emesis is caused by or is associated with adisease or condition selected from gastritis, ulcers, gastroparesis,poisoning, cancer, elevated intracranial pressure, motion sickness,seasickness, early stages of pregnancy, medication-induced vomiting,intense pain, emotional stress, gallbladder disease, infections,overeating, heart attack, concussion, brain injury, brain tumor,bulimia, and overexposure to ionizing radiation. Each possibilityrepresents a separate embodiment of the invention.

In certain embodiments, the therapeutic potency of the pharmaceuticalcomposition is increased compared to the same pharmaceutical compositionwithout the N-acylethanolamine. In certain embodiments, the requiredtherapeutic dosage of the cannabinoid in the pharmaceutical compositionis decreased compared to the required therapeutic dosage of thecannabinoid in a similar pharmaceutical composition without the N-acylethanolamine In certain embodiments, at least one of theside-effects of the cannabinoid in the pharmaceutical composition isreduced by the use of the pharmaceutical composition compared to thesame side-effect while using a similar pharmaceutical compositionwithout the N-acylethanolamine In certain embodiments, the therapeuticwindow of the cannabinoid in the pharmaceutical composition is expendedcompared to the therapeutic window of the cannabinoid in a similarpharmaceutical composition without the N-acylethanolamine

In certain embodiments, the N-acylethanolamine increases the therapeuticpotency of the cannabinoid compared to the same pharmaceuticalcomposition without the N-acylethanolamine. In certain embodiments, theN-acylethanolamine decreases the required therapeutic dosage of thecannabinoid compared to the same pharmaceutical composition without theN-acylethanolamine In certain embodiments, the N-acylethanolaminereduces at least one of the side-effects of the cannabinoid compared tothe same pharmaceutical composition without the N-acylethanolamine. Incertain embodiments, the N-acylethanolamine expends the therapeuticwindow of the cannabinoid compared to the same pharmaceuticalcomposition without the N-acylethanolamine. In certain embodiments, thePEA or salt thereof increases the therapeutic potency of the THC or saltthereof compared to the same pharmaceutical composition without the PEAor salt thereof. In certain embodiments, the PEA or salt thereofdecreases the required therapeutic dosage of the THC or salt thereofcompared to the same pharmaceutical composition without the PEA or saltthereof. In certain embodiments, the PEA or salt thereof reduces atleast one of the side-effects of the THC or salt thereof compared to thesame pharmaceutical composition without the PEA or salt thereof. Incertain embodiments, the PEA or salt thereof expends the therapeuticwindow of the THC or salt thereof compared to the same pharmaceuticalcomposition without the PEA or salt thereof.

The phrase “N-acylethanolamine increases the therapeutic potency of thecannabinoid” as used herein refers to the significantly improvedtherapeutic effect of the cannabinoid when administered with anN-acylethanolamine, compared to the therapeutic effect of thecannabinoid when administered without the N-acylethanolamine.

The phrase “N-acylethanolamine decreases the required therapeutic dosageof the cannabinoid” as used herein refers to the significantly lowerdosage required to achieve a certain therapeutic effect of thecannabinoid when administered with an N-acylethanolamine, compared tothe N-acylethanolamine dosage required to achieve the same therapeuticeffect when the cannabinoid is administered without theN-acylethanolamine.

The phrase “N-acylethanolamine reduces at least one of the side effectsof the cannabinoid” as used herein refers to the significantly lowerseverity of at least one of the side effects of the cannabinoid when thecannabinoid is administered with an N-acylethanolamine, compared to theseverity of the same side effect when the cannabinoid is administeredwithout the N- acylethanolamine.

The phrase “N-acylethanolamine prolongs the therapeutic window of thecannabinoid” as used herein refers to the significantly longer period inwhich the cannabinoid has a therapeutic effect when administered with anN-acylethanolamine, compared to the period in which the cannabinoid hasa therapeutic effect when administered without the N-acylethanolamine

The present invention further provides, in another aspect, apharmaceutical composition or a dosage unit as described above for usein a method for preventing or treating at least one side-effectassociated with cannabinoid consumption.

In certain embodiments, the pharmaceutical composition or a dosage unitas described above for use in a method for preventing or treating atleast one side-effect associated with cannabinoid consumption comprisesthe cannabinoid and the N-acylethanolamine in a molar ratio betweenabout 1:0.2 to about 1:5.

Emesis (vomiting) is the involuntary, forceful expulsion of the contentsof one's stomach through the mouth and sometimes the nose. Vomiting canbe caused by a wide variety of conditions; it may present as a specificresponse to ailments like gastritis or poisoning, or as a non-specificsequela of disorders ranging from brain tumors and elevated intracranialpressure to overexposure to ionizing radiation. The feeling that one isabout to vomit is called nausea, which often proceeds, but does notalways lead to, vomiting. Antiemetics are sometimes necessary tosuppress nausea and vomiting. In severe cases, where dehydrationdevelops, intravenous fluid may be required.

Anorexia is the decreased sensation of appetite. While the term innon-scientific publications is often used interchangeably with anorexianervosa, many possible causes exist for a decreased appetite, such asthose listed above. Anorexia nervosa is an eating disorder characterizedby a low weight, fear of gaining weight, a strong desire to be thin, andfood restriction.

The primary effects of cannabis are caused by the chemical compounds inthe plant, including cannabinoids, such as tetrahydrocannabinol (THC).Cannabis has psychological and physiological effects on the human body.Cannabinoid consumption may lead to short and/or long-term effects.Short-term effects, generally ranging from 10 minutes to 8 hours,include, but are not limited to, psychoactive effects (known as a“high”), and somatic effects, such as increased heart rate, dry mouth,congestion of the conjunctival blood vessels (reddening of the eyes),reduction in intra-ocular pressure, muscle relaxation and a sensation ofcold or hot hands and feet. Long-term effects include, but are notlimited to, risk of irreversible cognitive impairment, anxiety,schizophrenia, and depression. Cannabis “use disorder” is defined as amedical diagnosis in the fifth revision of the Diagnostic andStatistical Manual of Mental Disorders (DSM-5).

In certain embodiments, the side-effect is increased appetite. Incertain embodiments, the side-effect is body-weight gain. In certainembodiments, the side-effect is increased appetite and body-weight gain.In certain embodiments, the side-effect is confusion. In certainembodiments, the side-effect is disorientation. In certain embodiments,the side-effect is confusion and disorientation. In certain embodiments,the side-effect is anxiety.

The present invention further provides, in another aspect, a method forpreventing or treating a condition amenable to prevention or treatmentby at least one cannabinoid in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof.

In certain embodiments, the condition is an acute or a chronicneuropathic pain. In certain embodiments, the pain is caused by or isassociated with a disease or condition selected from diabetes, anadverse metabolic condition, herpes zoster infection, an HIV-relatedneuropathy, a nutritional deficiency, a toxin, a malignancy, an immunemediated disorder, a physical trauma, a chemotherapy-induced peripheralneuropathy, alcoholism, multiple sclerosis, radiation injury or surgery.Each possibility represents a separate embodiment of the invention.

In certain embodiments, the condition is emesis. In certain embodiments,the emesis is caused by or is associated with a disease or conditionselected from gastritis, ulcers, gastroparesis, poisoning, cancer,elevated intracranial pressure, motion sickness, seasickness, earlystages of pregnancy, medication-induced vomiting, intense pain,emotional stress, gallbladder disease, infections, overeating, heartattack, concussion, brain injury, brain tumor, bulimia, and overexposureto ionizing radiation. Each possibility represents a separate embodimentof the invention.

In certain embodiments, the condition is anorexia. In certainembodiments, the anorexia is caused by or is associated with a diseaseor condition selected from acquired immune deficiency syndrome (AIDS),acute radiation syndrome, acute viral hepatitis, addison's disease,atypical pneumonia, (mycoplasma), anorexia nervosa, anxiety disorder,appendicitis, cancer, chronic pain, chronic kidney disease, congestiveheart failure, congestion of the liver with venous blood, Crohn'sdisease, dehydration, dementia, drug addiction, depression,hypervitaminosis D, a metabolic disorder, an urea cycle disorder,sickness behavior, superior mesenteric artery syndrome, tuberculosis,thalassemia, ulcerative colitis, and zinc deficiency. Each possibilityrepresents a separate embodiment of the invention.

In certain embodiments, the condition is a side effect associated withcannabinoid consumption. In certain embodiments, the side effect iscaused by or is associated with a disease or condition selected fromacute impaired cognitive function, and hypertriglyceridemia. In certainembodiments, the acute impaired cognitive function is selected from thegroup consisting of an impaired ability to plan, of an impaired abilityto organize, of an impaired ability to solve problems, of an impairedability to make decisions, and of an impaired ability to controlimpulses. Each possibility represents a separate embodiment of theinvention.

The present invention further provides, in another aspect, a method forpreventing or treating at least one symptom of Tourette syndrome in ahuman subject in need thereof, the method comprising the step ofadministering to the subject a therapeutically-effective amount of acombination of a pharmaceutical composition comprising at least onecannabinoid or a salt thereof and a pharmaceutical compositioncomprising at least one N-acylethanolamine or a salt thereof, therebypreventing or treating the at least one symptom of Tourette syndrome.

The present invention further provides, in another aspect, a method forpreventing or treating pain in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, thereby preventing or treating pain.

The present invention further provides, in another aspect, a method forpreventing or treating emesis in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, thereby preventing or treating emesis.

The present invention further provides, in another aspect, a method forpreventing or treating at least one side-effect associated withcannabinoid consumption in a human subject in need thereof, the methodcomprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, thereby preventing or treating the at least oneside-effect.

The present invention further provides, in another aspect, a method forpreventing or treating a condition amenable to prevention or treatmentby at least one cannabinoid in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating the condition.

The present invention further provides, in another aspect, a method forpreventing or treating at least one symptom of Tourette syndrome in ahuman subject in need thereof, the method comprising the step ofadministering to the subject a therapeutically-effective amount of acombination of a pharmaceutical composition comprising at least onecannabinoid or a salt thereof and a pharmaceutical compositioncomprising at least one N-acylethanolamine or a salt thereof, whereinthe molar ratio between the administered cannabinoid andN-acylethanolamine is between about 1:0.2 to about 1:2000, therebypreventing or treating the at least one symptom of Tourette syndrome.

The present invention further provides, in another aspect, a method forpreventing or treating pain in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating pain.

The present invention further provides, in another aspect, a method forpreventing or treating emesis in a human subject in need thereof, themethod comprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating emesis.

The present invention further provides, in another aspect, a method forpreventing or treating at least one side-effect associated withcannabinoid consumption in a human subject in need thereof, the methodcomprising the step of administering to the subject atherapeutically-effective amount of a combination of a pharmaceuticalcomposition comprising at least one cannabinoid or a salt thereof and apharmaceutical composition comprising at least one N-acylethanolamine ora salt thereof, wherein the molar ratio between the administeredcannabinoid and N-acylethanolamine is between about 1:0.2 to about1:2000, thereby preventing or treating the at least one side-effect.

In certain embodiments of the methods described above, the cannabinoidand the N-acylethanolamine are comprised in the same pharmaceuticalcomposition. In certain embodiments of the methods described above, thecannabinoid and the N-acylethanolamine are comprised in differentpharmaceutical compositions.

In certain embodiments of the methods described above, theadministration of the cannabinoid and the N-acylethanolamine isrepeated. In certain embodiments of the methods described above, theadministration of the cannabinoid and the N-acylethanolamine is repeatedthree times a day. In certain embodiments of the methods describedabove, the administration of the cannabinoid and the N-acylethanolamineis repeated twice a day. In certain embodiments of the methods describedabove, the administration of the cannabinoid and the N-acylethanolamineis repeated once a day. In certain embodiments of the methods describedabove, the administration of the cannabinoid and the N-acylethanolamineis repeated once every two days. In certain embodiments of the methodsdescribed above, the administration of the cannabinoid and theN-acylethanolamine is repeated once every three days.

In certain embodiments of the methods described above, theadministration of the cannabinoid and the N-acylethanolamine is repeateduntil achieving a beneficial change in the condition of the subjectaccording to the Yale Global Tic Severity Scale (YGTSS) compared to hiscondition prior to treatment. In certain embodiments of the methodsdescribed above, the administration of the cannabinoid and theN-acylethanolamine is repeated until achieving a beneficial change inthe condition of the subject according to at least one scale selectedfrom the group consisting of (i) the Clinician Global Impression scale(CGIS), (ii) the Gilles de la Tourette Syndrome-Quality Of Life scale(GTS-QOL) (iii) the Tourette Syndrome Symptom List (TSSL) (iv) theYale-Brown Obsessive Compulsive Scale (Y-BOCS) (v) the

ADHD Rating Scale-IV (ADHD-RS) and (vi) the Hamilton Anxiety RatingScale (HAM-A), compared to his condition prior to treatment. Eachpossibility represents a separate embodiment of the present invention.

The term “about” as used herein in relation to a value, a plurality ofvalues or a range of values defined by a lowest and highest values meansa value which is 10% lower and/or higher than the corresponding value,plurality of values or range of values. For example, the phrase “about1” means “0.9 to 1.1”, the phrase “about 1 or 2” means “0.9 to 1.1 or1.8 to 2.2”, and the phrase “about 1 to about 2” means “0.9 to 2.2”.

While the present invention has been described with reference to certainembodiments, it will be understood by those skilled in the art thatvarious changes may be made and equivalents may be substituted withoutdeparting from the scope of the present invention. In addition, manymodifications may be made to adapt a particular situation or material tothe teachings of the present invention without departing from its scope.Therefore, it is intended that the present invention not be limited tothe particular embodiment disclosed, but that the present invention willinclude all embodiments falling within the scope of the appended claims.

The following examples are presented in order to more fully illustratesome embodiments of the invention. They should, in no way be construed,however, as limiting the broad scope of the invention.

EXAMPLES Materials and Methods

THC formulation for 50 and 12.5 mg/kg dose levels—THC arrived at a 16.7%(Dronabinol) concentration in sesame oil. THC was diluted in a 1:1:18ratio of ethanol:cremophor:saline mixture. In order to achieve a 5 mg/mlconcentration at 100% dose, 200 μl were mixed with 325 μl ethanol, with325 μl cremophor and diluted in 5850 μl saline. The same mixture wasdiluted ×4 with 1.3 ml ethanol, 1.3 ml cremophor and 23.4 ml saline inorder to achieve 1.25 mg/ml concentration. The formulations wereprepared twice, once for the open field test and again for the tailpinch test.

PEA formulation for 25 mg/kg dose level—PEA was prepared at a 5 mg/mlconcentration by dissolving 30 mg PEA in 6 ml ofethanol:cremophor:saline mixture at a 1:1:18 ratio. To prepare 2.5 mg/mlPEA, 4 ml from the previous mixture were diluted with 4 ml ofethanol:cremophor:saline mixture at a 1:1:18 ratio. The formulationswere prepared twice, once for the open field test and again for the tailpinch test.

Animals—Mice, strain ICR, male, 8 weeks of age at study initiation. Theaverage animal body weight at study initiation was in the range of31.97±1.61 g. The minimum and maximum weight in each group did notexceed ±20% of group mean weight Animals were randomly allocated toindividual cages on the day of reception Animals were acclimated forseven to nine days.

TABLE 1 Group allocation Group Test item (mg/kg) N Dose Volume (ml/kg)1M Vehicle 6 10 2M THC (50) 5 3M THC (12.5) 6 4M PEA (25) + THC (50) 65M PEA (25) + THC (12.5) 6

Test item was administered IP at a dose volume of 10 ml/kg according tothe doses in Table 1. Dosing was performed 15 minutes before each of thebehavioral tests.

TABLE 2 Equivalent Murine/Human dosages Group Test item Murine doseHuman dose Drug molar ratio * 2M THC 50 mg/kg — 3M THC 12.5 mg/kg — 4MTHC 50 mg/kg 2 PEA 25 mg/kg 1 5M THC 12.5 mg/kg 1 PEA 25 mg/kg 2THX-TP-05 THC 5 mg 1 PEA 518 mg 100 THX-TP-10 THC 10 mg 1 PEA 518 mg50 * The M.W of THC is 314.469 g/mol, and the M.W of PEA is 299.50g/mol.

Open Field (OF) tests were performed as follows—Fifteen minutes aftertest item/vehicle administration, mice were placed at the center of anopen field box (43×43×40 cm) between 9 AM and 5 PM. On each side of theopen field box, two frames placed at 2 and 5 cm height with 16 photocellbeams per side ensure movement detection. The computer defined gridlines that divided the open field into two compartments: margin andcenter. Several variables were recorded during a 15 minute session ofspontaneous activity including: time spent moving, traveled distance,time spent and number of visits to the central compartment.

Tail pinch tests were performed as follows, according to the modifiedHaffner's method (as depicted in Takagi et al., Jpn. J. Pharmacol.,1966, 16, Pages 287-294)—Mice were pretested by pinching their tail basewith an artery clip (1.5 mm width, constant force), and only the micethat show a nociceptive response such as biting the clip or vocalizingwithin 2 sec were used for experiments. When the mice did not show theabove-mentioned behaviors up to 6 sec after pinching, theantinociceptive effect was regarded as positive. To prevent tissuedamage, the pressure stimuli was not applied for more than 10 sec. Afterdrug treatments, the nociceptive response in the tail-pinch test wasmeasured at varying intervals.

Statistical analysis—Numerical results were given as means ±standarderror of the mean. The results were subjected either to a T-test or totwo-way ANOVA, followed by Bonferroni post-hoc contrast analysis betweenthe groups where applicable. A probability of less than 5% (p<0.05) wasregarded as significant.

Example 1 Body Weight Gain

Body weight (BW) gain was observed in all groups throughout the study.BW gain was significantly reduced (p<0.01) in group 4M and increased(p<0.05) in group 3M compared to group 1M. Group averages as BW (±SEM)percentage change from arrival throughout the study are presented inFIG. 1.

The data presented in FIGS. 1A and 1B demonstrates the characteristicweight gain commonly associated with cannabinoid uptake (2M and 3M vs.1M, respectively), and the prevention or reduction of this adverseside-effect upon co-administration of N-acylethanolamines (4M and 3M vs.5M, respectively).

Example 2 Animal Velocity

Average animal velocity, associated in mice with uncontrolled movementwas calculated by dividing the total distance traveled (cm) by eachanimal by the total moving time (sec) during a 15 minute session in anopen field test. THC at 50 mg/kg significantly increased the velocitycompared to control (2M vs. 1M) while THC at 12.5 mg/kg (3M) had noeffect. PEA in combination with THC at 50 mg/kg (4M) had only moderatelyaffected velocity (4M), while PEA in combination with THC at 12.5 mg/kg(5M) significantly reduced the velocity. Of particular interest, onlygroup 2M, but not group 4M, demonstrated a significant increased levelof uncontrolled movement. Of another particular interest, only group 5M,but not group 3M, demonstrated a significant reduced level ofuncontrolled movement. Together, the data presented in FIG. 2demonstrates that co-administration of N-acylethanolamines, in additionto cannabinoid uptake, is able to significantly prevent or reduceuncontrolled movement in mice. This ability is equivalent to preventingor minimizing adverse side-effects in human commonly associated withcannabinoid uptake, such as confusion and/or disorientation (Metrik J.et al., J. Cogn. Psychother., 2011, pages 1-18).

Example 3 Time Spent in the Center of an Arena

Total time spent in the center of an arena, which is a measure ofanxiety, was evaluated during a 15 minute session in the open fieldtest. THC at 50 mg/kg (2M) had decreased the time spent in the center,while PEA combined with THC at 50 mg/kg (4M) had increased the timespent in the center. The data presented in FIG. 3 demonstrates thatco-administration of N-acylethanolamines, in addition to cannabinoiduptake, is able to prevent or reduce anxiety, another adverseside-effect in human commonly associated with cannabinoid uptake.

Example 4 Tail Pinch Test

The tail pinch test was performed 15 minutes after the administration ofthe indicated test item. Pressure was applied to the base of the tailfor no more than 10 seconds. The latency to respond in the high dose THCtreated group (2M) was higher compared to the control as can be seen inFIG. 4A. Addition of PEA to the high dose THC further significantlyenhanced the latency time of the high dose THC (4M). Of particularinterest, at 15′ post administration only group 4M exhibited ananalgesic effect, which attests to the potential of the combination ofN-acylethanolamines and cannabinoids in achieving an almost immediateanalgesic effect. As depicted in FIG. 4A, the combination ofN-acylethanolamines and cannabinoids is particularly potent 45′ postadministration. Thus, the combination of N-acylethanolamines andcannabinoids is both fast-acting and highly-potent in preventing orminimizing pain.

The latency to respond in the low dose THC treated group (3M) was highercompared to the control as can be seen in FIG. 4B. Addition of PEA tothe low dose THC further significantly enhanced the latency time of thelow dose THC (5M). Of particular interest, at 15′ post administrationboth groups 3M and 5M exhibited an analgesic effect. As depicted in FIG.4B, the combination of N-acylethanolamines and cannabinoids isparticularly potent 45′ and 90′ post administration. Thus, thecombination of N-acylethanolamines and cannabinoids is fast-acting,highly-potent and long-lasting in preventing or minimizing pain. Thedata presented in FIG. 4B is particularly surprising since the minimaleffective dose of THC as an analgesic is widely considered to be 20mg/kg (Buxbaum D M., Psychopharmacologia, 1972, Vol. 25(3), pages275-280). Therefore, groups 3M and 5M, both relating to theadministration of 12.5 mg/kg THC, which is considered a sub-therapeuticdose, were not expected to provide any measurable analgesic effect.

Example 5 Phase IIa, Randomized, Double-Blind, Parallel-Group, PlaceboControlled Study

Study groups—THX-TP-2.5-10 (A capsule of 2.5-10 mg Dronabinol® and 2capsules of 259 mg PEA). For example, THX-TP-05 (A capsule of 5 mgDronabinol® and 2 capsules of 259 mg PEA) and THX-TP-10 (A capsule of 10mg Dronabinol® and 2 capsules of 259 mg PEA). Control group—Placebo.

Overall Study Design: A multicenter, randomized, double-blind,parallel-group, placebo-controlled study designed to evaluate thetolerability, safety and efficacy of once daily oral THX-TS in treatingadults with moderate to severe Tourette syndrome according to DSM-Vcriteria. The dosage is titrated up to the target dosage and the samedosing schedule is used to reduce medication at the end of the treatmentperiod. The study is comprised of two main phases: a treatment phase anda follow-up phase. Eligible consenting subjects are randomized in adouble-blind fashion in a 1:1:1 ratio to receive study treatment(TRX-TS-05 or THX-TS-10) or placebo (Control). Treatment Phase (6-10weeks): Subjects receive once a day treatment for 6-10 weeks. Visitsduring the treatment phase commence on Day 0 with a total of 5 visits.The final double blind treatment visit occurs on TP5, about 6-10 weeksafter baseline visit. Follow-Up Phase (4 weeks): Subjects aftercompleting the treatment phase continue into the Follow-Up phase,returning for study visits after study medication is gradually stopped.The first follow up visit (FU1) occurs within 2 days after the studymedication is gradually stopped by down titration followed by atermination visit up to 4 weeks after study medication completewithdrawal.

Baseline visit: Assessments at Baseline include: Vital signs(temperature, pulse, blood pressure); Laboratory testing (Blood andurine tests of dronabinol and its metabolites to exclude additionalcannabis use and to control compliance); Assessment of physiologicalsymptoms (motor and vocal tics); Assessment of cognitive functions;Adverse events (AEs) and Concomitant medications; Subjects who meet alleligibility criteria, as per data gathered from Screening and Baselinevisits, are randomized. All patients who fail to meet eligibilitycriteria at Baseline are considered screen failures and are exited thestudy without further evaluation.

Randomization: After subject is reviewed by the Principal Investigatorto confirm the patient's eligibility for the trial the patient israndomized Randomization is performed by the Principal Investigator.Both the Principal Investigator and the subject remain blinded to thestudy treatment.

Treatment Phase: The initial treatment is administered within 1 dayafter Randomization. Patients receive study treatment throughout theTreatment Phase. During Treatment Phase, several assessments areperformed, including hut not limited to Physical examination; Vitalsigns (temperature, pulse, blood pressure); Laboratory tests of serumchemistry, liver and renal function tests, hematology, serum pregnancytest; Laboratory testing (Blood and urine tests of dronabinol and itsmetabolites to exclude additional cannabis use and to controlcompliance); Assessment of physiological symptoms (motor and vocaltics); Assessment of cognitive functions; Adverse events (AEs) andconcomitant medications.

End of Treatment Phase: Once the 6-10 weeks of treatment are completedand the study medication withdrawal, the subject completes participationin this phase and moves into the follow up phase. At the last visit,(TP5), the subject undergoes all TP assessments, as described above.

Follow Up phase: All subjects who complete the Treatment Phase, completethe TP5 assessments and enter follow up phase. In the Follow Up phase,subjects return for 2 follow up assessments, one within 2 days of drugswithdrawal. At these visits, the following assessments are performed:Vital signs (heart rate, temperature, blood pressure); Adverse eventinventory and update of concomitant medications and therapies. Theprimary objective of the study is to evaluate the clinical benefit ofonce-daily application of THX-TS in reducing total tic severity inadults with Tourette's Syndrome compared to placebo at up to 10 weeksfollowing baseline visit. Additional objectives are to demonstratesafety and tolerability of THX-TS (study drug) compared to placebo(Control). Patients are randomized to treatment with either studycombination drug or placebo based on 1:1:1 assignment ratio.

Inclusion Criteria: To be eligible for the study, subjects must fulfillall of the following criteria at Screening and Baseline, as applicable:(1) Males or females between 6 and 65 years of age (inclusive) with adiagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V) diagnosis of Tourette syndrome or chronic motor tic disorder;(2) Subjects must sign an informed consent that complies withInternational Conference on Harmonization (ICH) guidelines andapplicable local regulatory requirements prior to undergoing anystudy-related procedures; (3) Have at least moderate tic severity; or(4) Yale Global Tic Severity Scale Score (YGTSS) ≥20 with TS diagnosisor ≥14 for a Chronic Tic disorder ; (5) Subjects with comorbidconditions: a mild degree of Oppositional defiant disorder (ODD) orAttention Deficit Hyperactivity Disorder (ADHD) and mild to moderatedegree of Obsessive Compulsive Disorder (OCD); (6) Patient is in goodgeneral health, as indicated by medical and major psychiatric disordershistory and physical examination. (7) Subjects must agree to avoidalcohol and substance abuse (e.g. amphetamines, barbiturates,benzodiazepine, phencyclidine, cocaine, or opiates); (8) Women ofchildbearing potential must have a negative serum pregnancy test andwill use at least one reliable form of birth control (e.g. oralcontraceptive for at least 3 months prior to screening or anintrauterine device or a combination of condom and spermicide)throughout the study; (9) Subjects must agree to comply with drugapplication regimen;

Exclusion Criteria: Patients meeting any of the following criteria willbe excluded from the study at Screening and Baseline, as applicable: (1)Subjects with an active, clinically significant unstable medicalcondition within 1 month prior to screening; (2) Patient with aprogressive or degenerative neurological disorder and major psychiatricsdisorder that preclude the patients from participating in the studyother than TS, ADHD, ODD, OCD, or a structural disorder of the brain;(3) Subjects with a known allergy, hypersensitivity, or intolerance tocannabis, cannabinoids, fish oil, sesame oil, canola oil or any of thedrugs compounds; (4) Subjects that have initiated ComprehensiveBehavioral Intervention for Tics (CBIT) during the screening period orat baseline or plan to initiate CBIT during the study; (5) Patient iscurrently being treated with deep brain stimulation for control of tics;(6) Subjects that have received an investigational drug or device trialwithin 30 days before screening or plan to use an investigational drug(other than THX-TS-05 and THX-TS-10) during the study; (7) Anycondition, which in the opinion of the Investigator, would interferewith the evaluation of the study product or poses a health risk to thesubject.

Dose, Route & Dosage Form: All dosages of THX-TS (such as THX-TP-05,THX-TP-10) or placebo should be orally administered at least once a day,for example twice a day or trice a day, until study completion; Thedosage will be titrated to a target dosage of dronabinol. Starting at2.5 mg per day, the dose will be increased by increments of 2.5 mg perday until the desired dose is achieved; PEA dosage is constantthroughout the treatment phase (518 mg/day); If a subject could nottolerate the maximum dose, an adjustment could be made by decreasingstudy medication, until a tolerated dose is achieved; Subjects assignedto the placebo group will receive identical placebo throughout the studyin a similar fashion; Patients will be instructed to take the medicationonce a day in the morning together with breakfast.

Outcome Measures

Primary Efficacy Endpoint: The primary efficacy endpoint is the changefrom baseline to end of treatment phase in the Yale Global Tic SeverityScale (YGTSS).

Secondary Efficacy Endpoints: The secondary efficacy endpoints are thefollowing: Change from baseline to end of treatment phase in ClinicianGlobal Impression Scale (CGIS); Change from baseline to end of treatmentphase in Gilles de la Tourette syndrome-quality of life scale (GTS-QOL);Change from baseline to end of treatment phase in Tourette SyndromeSymptom List (TSSL); Change from baseline to end of treatment phase inYale-Brown Obsessive Compulsive scale (Y-BOCS); Change from baseline toend of treatment phase in ADHD Rating Scale-IV (ADHD-RS); Change frombaseline to end of treatment phase in Hamilton Anxiety Rating Scale(HAM-A); Proportion of patients with a negative outcome related toTourette syndrome, defined by any of the following events during thetreatment phase: worsening of tic severity and/or in comorbidconditions, early discontinuation from study due inadequate effect oradverse events.

Tolerability Endpoints: The tolerability measures are as follows:Proportion of patients who discontinued early from the study; Proportionof patients who discontinued study treatment early due to adverseexperiences; Proportion of patients who withdrew from the study; Time toearly study discontinuation; Time to early study treatmentdiscontinuation due to adverse events; and Time to withdrawal from thestudy.

Safety Endpoints: The safety endpoints are the following: Frequency andtype of AEs; Intensity of AEs; Frequency and type of related AEs;Frequency and type of SAEs; Change From Baseline in Suicidal IdeationIntensity Total Score Based on Columbia-Suicide Severity Rating Scale(C-SSRS); Assessment of Cognitive Function: German Version of AuditoryVerbal Learning Test (VLMT); Benton Visual Retention Test (BVRT);Divided Attention (TAP); Multiple Choice Vocabulary Test (NWT-B).

While certain features of the invention have been illustrated anddescribed herein, many modifications, substitutions, changes, andequivalents will now occur to those of ordinary skill in the art. It is,therefore, to be understood that the appended claims are intended tocover all such modifications and changes as fall within the true spiritof the invention.

1-48. (canceled)
 49. A pharmaceutical composition comprising atherapeutically-effective amount of at least one synthetic cannabinoidor a salt thereof, and at least one N-acylethanolamine or a saltthereof.
 50. The pharmaceutical composition of claim 49, wherein themolar ratio between the at least one synthetic cannabinoid or saltthereof, and the at least one N-acylethanolamine or salt thereof isbetween about 1:0.2 to about 1:2000.
 51. The pharmaceutical compositionof claim 49, wherein the molar ratio between the at least one syntheticcannabinoid or salt thereof, and the at least one N-acylethanolamine orsalt thereof is between about 1:0.2 to about 1:5.
 52. The pharmaceuticalcomposition of claim 49, wherein the molar ratio between the at leastone synthetic cannabinoid or salt thereof, and the at least oneN-acylethanolamine or salt thereof is between about 1:0.5 to about 1:2.53. The pharmaceutical composition of claim 49, wherein the molar ratiobetween the at least one synthetic cannabinoid or salt thereof, and theat least one N-acylethanolamine or salt thereof is between about 1:15 toabout 1:1800.
 54. The pharmaceutical composition of claim 49, whereinthe molar ratio between the at least one synthetic cannabinoid or saltthereof, and the at least one N-acylethanolamine or salt thereof isbetween about 1:25 to about 1:450.
 55. The pharmaceutical composition ofclaim 49, wherein the molar ratio between the at least one syntheticcannabinoid or salt thereof, and the at least one N-acylethanolamine orsalt thereof is between about 1:50 to about 1:100.
 56. Thepharmaceutical composition of claim 49, comprising about 200-1800 mg ofN-acylethanolamine or salt thereof.
 57. The pharmaceutical compositionof claim 56, comprising about 250 mg, about 500 mg, about 750 mg, about1000 mg or about 1500 mg of the N-acylethanolamine or salt thereof. 58.The pharmaceutical composition of claim 49, wherein theN-acylethanolamine is selected from the group consisting ofN-palmitoylethanolamine (PEA), Me-palmitoylethanolamide (Me-PEA),palmitoylcyclohexamide, palmitoylbutylamide, palmitoylisopropylamide,oleoylethanolamine (OEA), palmitoylisopropylamide (PIA), a salt thereof,or any combination thereof.
 59. The pharmaceutical composition of claim58, wherein the N-acylethanolamine is PEA or a salt thereof
 60. Thepharmaceutical composition of claim 59, wherein the pharmaceuticalcomposition comprises about 0.5-10 mg of the synthetic cannabinoid orsalt thereof, and about 200-1800 mg of the PEA or salt thereof.
 61. Thepharmaceutical composition of claim 60, wherein the pharmaceuticalcomposition comprises about 2.5-10 mg of the synthetic cannabinoid orsalt thereof, and about 250-1000 mg of the PEA or salt thereof.
 62. Thepharmaceutical composition of claim 61, wherein the pharmaceuticalcomposition comprises about 2.5 mg, about 5 mg, about 7.5 mg or about 10mg the synthetic cannabinoid or salt thereof, and about 250 mg, about500 mg, about 750 mg or about 1000 mg of the PEA or salt thereof. 63.The pharmaceutical composition of claim 49, wherein the pharmaceuticalcomposition is formulated for oral, oral mucosal, nasal, sublingual,inhalational, topical, rectal, vaginal, parenteral, intravenous,intramuscular, or subcutaneous administration.
 64. The pharmaceuticalcomposition of claim 63, wherein the pharmaceutical composition isformulated for oral, oral mucosal, nasal, or sublingual administration.65. The pharmaceutical composition of claim 49, wherein the therapeuticpotency of the pharmaceutical composition is increased compared to thesame pharmaceutical composition without the N-acylethanolamine.
 66. Thepharmaceutical composition of claim 49, wherein the required therapeuticdosage of the synthetic cannabinoid in the pharmaceutical composition isdecreased compared to the same pharmaceutical composition without theN-acylethanolamine.
 67. The pharmaceutical composition of claim 49,wherein at least one of the side-effects of the synthetic cannabinoid isreduced compared to the same pharmaceutical composition without theN-acylethanolamine.
 68. The pharmaceutical composition of claim 49,wherein the therapeutic window of the synthetic cannabinoid is extendedcompared to the same pharmaceutical composition without theN-acylethanolamine.
 69. A pharmaceutical composition comprising atherapeutically-effective amount of at least one synthetic cannabinoidor a salt thereof, and at least one N-acylethanolamine or a saltthereof, wherein the molar ratio between the at least one syntheticcannabinoid and the at least one N-acylethanolamine is between about1:0.2 to about 1:2000.
 70. The pharmaceutical composition of claim 69,wherein the N-acylethanolamine is selected from the group consisting ofN-palmitoylethanolamine (PEA), Me-palmitoylethanolamide (Me-PEA),palmitoylcyclohexamide, palmitoylbutylamide, palmitoylisopropylamide,oleoylethanolamine (OEA), palmitoylisopropylamide (PIA), a salt thereof,or any combination thereof.
 71. The pharmaceutical composition of claim70, wherein the N-acylethanolamine is PEA or a salt thereof
 72. Thepharmaceutical composition of claim 71, wherein the pharmaceuticalcomposition comprises about 200-1800 mg of the PEA or salt thereof. 73.The pharmaceutical composition of claim 72, wherein the pharmaceuticalcomposition comprises about 250-1000 mg of the PEA or salt thereof. 74.The pharmaceutical composition of claim 73, wherein the pharmaceuticalcomposition comprises about 250 mg, about 500 mg, about 750 mg or about1000 mg of the PEA or salt thereof.
 75. The pharmaceutical compositionof claim 69, wherein the pharmaceutical composition is formulated fororal, oral mucosal, nasal, or sublingual administration.
 76. Thepharmaceutical composition of claim 71, wherein the therapeutic potencyof the pharmaceutical composition is increased compared to the samepharmaceutical composition without the PEA.